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15040210 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20990 HOMESTEAD RD CONTRACTOR:• PERMIT NO: 15040210 D OWNER'S NAME: SILVERCREEK YUBA LLC DATE ISSUED:04/28/2015 OWNER'S PHONE: 4083933522 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ,r REPLACE CLEANOUT AT BUILDING. License Class "t 2— L�iic.�#/ Contractor C'1 QG� r" Y–vc�E Date ' I hereby affirm that I am licensed under thl provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area:VmvValuation:$670 e and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32609060.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION ertify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, n- / �� costs,and expenses which may accrue against said City in consequence of the Issued b !y Date: �� granting of this permit. Additionally,the applicant understands and will comply y' with all non-point source regulations per the Cupertino Municipal Code,Section 918. 2 RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Date: Signature of Applicant: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the roe y g HAZARDOUS MATERIALS DISCLOSURE property,rty,am exclusive) contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505 25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: . permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature Date La GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 misc GUPERTINQ (408)777-3228•FAX(408)777-3333•buildingacupertino.org 1 'LUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 2_ 0 9 I L-) M �� APN# /'_ , OWNER NAME f�Y �'� LL C' PHONE /`5, �C:2�Q�ZZ E-MAIL �V G V _l/ ✓ Ma i {M C\ STREET ADDRESS ^ CITY,STATE,ZIP FAX CONTACT NAME �_ /�A PHON) `)�`i[ Gnt�� i EMAIL (� STREET ADDRESS ]G�V /[ CITY,STATE,ZIP G v C�_ c Lr�( FAX 11 OWNER UK -BUILDER 1:1 OWNER AGENT ❑ CONTRACTOR 11 CONTRACTOR AGENT 11 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER �� ` / LICENSE T�'PE4 BUS.LIC# 6 COMPANY NAMEC E-MAIL 5 �— FAX STREET ADDRESS D CITY,ST ZIPS � PH4M -3 C'Z-2- ARCHITECT/ENGINEER ARCHITECT/ENGINEER NAME (L`ICENSE NUMBER �� BUS.LIC# J 1 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILYPROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES FE.CHLER THE BLDG AN ❑YES BUILDING. ❑COMMERCIAL TURBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO HOME? ❑NO DESCRIPTION OF WORK TOTAL VALUATION: 3W70 , yRECI3y" By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have rovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bution. I authorize representatives of Cupertino to enter the above-iden ified properly for inspection purposes. I cons ruc Signature of ApplicantJAgent: Date: SUPPLEMEN AL INFORMATION REQUIRED Mt2 DSEOAiliY w 2T, r Cout�IITR r `� ExrREss xi LARGE }-ka MAJOR r' MEPMiscApp_MLdoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 20990 homestead rd DATE: 04/28/2015 REVIEWED BY: sean APN: BP#: *VALUATION: $670 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition /Repair PRIMARY PENTAMATION 1 CPSS USE: Commercial Building PERMIT TYPE: i WORK Replace cleanout at building. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PCSEWER 1 # $25 TOTALS: $25.00 Rk a, u s �. ilec;lz J'lart('heck Plumb.Plan Check 0.0 hrs $0.00 El,c. Na,(:heck iL1e%h. Mcrwit Fee: Plumb.Permit Fee: IPPERMIT Elec. Permir Fee Other Alech. Trap. Other Plumb Insp. 0.0 hrs $48.00 Orher/Ilec.Ins,r Lj 1lech. htspt Fee: Phan7b. hasp. Fee: Lslec.Insl>.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These fees are based on the prelimina information available and are onl an estimate. Contact the Det or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Ilan Check 1�ee: suppl. N 1'ee PME Plan Check: $0.00 Permit Fee: slq'1r1. Irrs1>Fees PME Unit Fee: $25.00 PME Permit Fee: T-T- $48.00 C'onsiruction Tax: Administrative Fee: ]ADMIN $45.00 Work Without Permit? ®Yes (E) No $0.00 ,ldv°anced Planning 1,ees: Travel Documentation Fee: 1TRAVDOC $48.00 A Strong Motion Fee: IBSEISMICO $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 m '" $167.50 $ Taj' >,FEE: : $167.50 0.00 . 5�. Revised: 04/01/2015 �Ec,a�y MA4- -C-y L --I G- I uu 1►' S .r• =p US .r O O OSs � Q a o f\ N 3 �I^\ a to C) O C O S] T / ALIt`., s.. O w- 0 0 Cl) O ci LIJ E Homestead lanes Install clean-out downstream of the grease trap.Cast-iron SCH-40 1-4"Combo"Y" branch 2-4"45 degree elbows 6-4"S.S. repair couplings 1-4"cleanout body 1-4"clean-out brass cap 7'of 4" cast iron SCH-40 Install clean-out downstream of the grease trap. PVC SDR-26 1-4"Combo"Y" branch 2-4"45 degree elbows 6-4"couplings 1-4" cleanout body 1-4"clean-out PVC cap or plug 7'of 4" PVC SDR-26